Temporary Resident Visa – Outside Canada, and Super-Visas

Question Sheet
Background information – Admissibility

Y N Within the past two years, have you or a family member ever had tuberculosis of the
lungs or been in close contact with a person with tuberculosis?
Y N Do you have any physical or mental disorder that would require social and/or health
services, other than medication, during a stay in Canada?

Y N Have you ever remained beyond the validity of your status, attended school without
authorization or worked without authorization in Canada?
Y N Have you ever been refused any kind of visa, admission, or been ordered to leave
Canada or any other country?

Y N Have you ever committed, been arrested for, or been charged with or convicted of any
criminal offence in any country?

If you answer yes to any of the next 3 questions, complete IMM 5257 Schedule 1 –
Application for Temporary Resident Visa for further details.
Y N Did you serve in any military, militia, or civil defence unit or serve in a security
organization or police force (including non-obligatory national service, reserve or
volunteer units)?

Y N Are you, or have you ever been a member or associated with any political party, or other
group or organization which has engaged in or advocated violence as a means to
achieving a political or religious objective, or which has been associated with criminal
activity at any time?

Y N Have you ever witnessed or participated in the ill treatment of prisoners, or civilians,
looting or desecration of religious buildings?
IMM 5257 – APPLICATION FOR TEMPORARY RESIDENT VISA

1. Have you used any other name (nickname, maiden name, alias, etc.)?

Family name Given name

2. Citizenship

3. Current country of residence

Country Status From To

4. Previous countries of residence (resided for 6 months or more in any country in past 5
years)

Country Status From To

5. Is the country you are applying to, the same as your country of residence?

If no, Country Status From To

6. Current marital status

● Status
● Date (married or entered into common-law)
● Family name
● Given name

7. Have you previously been married or in a common-law relationship? Yes/No

● Type of relationship
● Family name
● Given name
● From
● To

8. Passport details
● Passport number
● Country of issue
● Issue date
● Expiry date

9. Current mailing address

 10. Residential address

11. Telephone number

● Canada/US/Other _____________________
● Canada/US/Other _____________________

12. Fax number

13. E-mail address

14. Details of visit to Canada

Purpose of visit:
● ____Business
● ____Tourism
● ____Short-Term Studies
● ____Returning Student
● ____Returning Worker
● ____Super Visa
● ____Other

15. How long do you plan to stay?

From(YYYY-MM-DD) To(YYYY-MM-DD)

16. Funds available for your stay

17. Name, address and relationship of any person(s) or institution(s) you will visit:

Name Name
Relationship to you Relationship to you

Address in Canada Address in Canada

25. Have you ever completed an English or French exam? IELTS, CELPIP, TEF

26. Have you been issued a certificate under the Provincial Nominee program?

27. Do you have a family member who is a Canadian citizen or permanent resident and is 18 or
older?

28. What is your native language/mother tongue?

29. Please list all the countries you have ever traveled to:

For education and employment history, use page 3 of IMM 5257

For family information use IMM 5645

Documents required
1. Original valid passport (must have at least one blank page, other than the last page).
2. Two photos meeting the specific requirements with name and date of birth on the back of
each one.
3. Proof of financial support.
4. Photocopy of your valid return ticket, if you have one.
5. Any additional documents required by the responsible.